Articles and Blogs

On December 27, 2018, a federal judge ruled in favor of hospital associations and hospitals challenging the reduction in reimbursement for drugs purchased at a discount under the 340B Program established in the 2018 Outpatient Prospective Payment System final rule (“2018 OPPS Rule”). Judge Rudolph Contreras of the United States District Court in Washington,... READ MORE

The Secretary of Health and Human Services (“HHS”) recently announced that Medicaid may allow hospitals and health systems to use funds to pay for patients’ housing.[1] HHS has already experimented with this idea by providing states with waivers under Section 1115 of the Social Security Act to expand Medicaid coverage to individuals experiencing homelessness.[2]... READ MORE

On December 11, 2018, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced that a critical access hospital in Colorado (the “Hospital”) will settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) by paying a civil penalty of $111,400 and adopting a corrective action... READ MORE

Health and Human Services (“HHS”) Secretary Alex Azar announced on Thursday, November 8, 2018 that HHS intends to reconsider some of the episode-based payment models that it withdrew almost one year ago. According to Secretary Azar, HHS is exploring new and improved episode-based payment models, including a mandatory bundled payment model for radiation oncology.[1]... READ MORE

Congress Sends Health Funding Package to President Congress completed the funding package for the 2019 Labor-HHS appropriations measure, which hikes funding for most Health and Human Services (“HHS”) agencies. On Wednesday, the House of Representatives voted, 361 to 61, to pass legislation to provide $178.1 billion in discretionary funding for the departments of Defense,... READ MORE

Ways and Means Subcommittee Explores Modernizing Stark Law On July 17, the House Ways and Means Committee Subcommittee on Health held a hearing on modernizing the Stark Law. Government and industry witnesses shared concerns about the inhibiting effect of the Stark Law on innovative payment models and value-based care. Subcommittee Chairman Peter Roskam (R-IL)... READ MORE

More Changes Ahead for 340B The Human Resources and Services Administration (“HRSA”) released a final rule delaying the effective date of implementation and enforcement of the previously issued final rule implementing the 340B Drug Discount Program. The delayed rule, which was originally published on January 5, 2017, established the methodology for calculating the 340B... READ MORE

The Cures Act addresses certain electronic health record (“EHR”) difficulties faced by physicians who practice primarily in ambulatory surgery centers (“ASCs”). Section 16003 explicitly excludes physicians who furnish substantially all of their Medicare services at ASCs from the penalties imposed under various programs for failure to adopt a certified EHR. Under the current Medicare... READ MORE

On January 12, 2017, the Department of Health and Human Services Office of Inspector General (“OIG”) published the “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities” Final Rule (“Final Rule”) revising and expanding its authority to exclude individuals and entities from participation in federal health care programs.... READ MORE

On December 20, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a Final Rule that included several changes to the recently implemented Comprehensive Care for Joint Replacement (“CJR”) program. The CJR Model is a retrospective bundled payment program limited to lower extremity joint replacement (“LEJR”) procedures and is designed to encourage hospitals... READ MORE